Hey everyone....Quincy, I hope you don't mind if I add a little bit to your answer. By the way, do you have anal involvement with your UC? If you do, you should be written up in a case report, because UC almost always spares the anus and begins at the rectum! Just out of curiosity, how far proximally does your UC go in your bowel?

As for twisten: So it does sound like you have Crohn's disease. As Quincy quite correctly put, Crohn's can involve anywhere in the GI tract from gum to bum as is often said! :D Not only are the lesions in CD skip lesions, they involve the entire thickness of the bowel wall while UC usually only involves the surface. It's a bit of a tradeoff because bad Crohn's disease is usually much worse than bad UC, but the risk for bowel cancer in UC is MUCH higher than in CD.

A couple of other things. Quincy gave a nice list of all the different forms of colitis, and he did differentiate UC and CD as being autoimmune. You were right to conclude that Inflammatory bowel disease only contains TWO entities...CD and UC which are both thought to be autoimmune conditions.

Both conditions can be associated with symptoms outside the bowel. The most common symptoms are: inflammatory arthritis (usually the larger joints, and can also be associated with sacroiliitis or ankylosing spondylitis), rashes (erythema nodosium on the shins, and also weird rashes called: pyoderma ganrenosum, keratodermia blenorrhagicum and circinate balanitis.....basically bad rashes involving the shins, feet and penile head respectively) and eye inflammation (iritis, uveitis, episcleritis). Additionally, UC can be associated with bowel cancer and a disease which destroys the bile ducts in the liver known as Primary Sclerosing Cholangitis.

Now, on to your drug therapy. Depending on how bad your Crohn's is, taking you off drugs actually might be a GOOD thing! In mild to moderate cases of Crohn's, usually you can put people in to remission with prednisone and SOMETIMES asacol, but there is no place for keeping someone on a drug long-term. HOWEVER, if the disease is more severe, or frequently relapses, then you can add in either imuran (azathioprine) or methotrexate to be taken even while in remission as a maintenance agent. Putting on a maintenance regimen is usually only done if a person has more than one relapse in a year, or the disease is quite severe. Additionally, there is very little role for maintenance therapy with a 5-ASA agent....those are much more useful in UC.

Hey quincy! How are ya...sorry...I didn't realize you were a she.

Yeah, it is surprising to hear that 5-ASA isn't meant for use in CD in most cases. Like I said, there is an exception. #1. In colonic Crohn's, you can often use sulfsalazine or another 5-ASA agent to induce remission. You're right that many people are on maintenance therapy for CD with 5-ASA agents, but the thing is, this is a placebo effect. Numerous trials have been done on this subject in the past 10 years to show that, once in remission, the people who took the placebo pill did just as well as those who took the 5-ASA tablet. In other words, Crohn's in the mild and moderate forms is very managable without any medication whatsoever to maintain remission. In more serious cases, the two drugs that have evidence to actually work are MTX and azathioprine. Now I know that you probably have lots of friends on 5-ASA, and that's because they're probably being treated by their family doctors, many of whom were taught to do this in med school. If you are in contact with a tertiary care center, you will see that none of the gastroenterologists use 5-ASA agents in CD except in certain special cases.

No, I don't have UC or CD, which I am thankful for, but let's just say I have the opportunity to be exposed to it.

Anyway, I know this board isn't to discuss medical management of stuff--I just wanted to put out "did you know" type of statement 'cause it is evident that a lot of people use 5ASA agents in CD when they're really not that helpful in the vast majority of cases.

Hi quincy! I am M! :D I don't know why I thought of you as M..probably because I think of Quincy Jones when I hear the name and he's M :)

Anyway, yeah, sorry, I didn't mean to say that 5-ASA drugs have NO role in CD...just very little. Yes...I also agree with you that UC and CD are very different diseases.

Again....my statement was that 5-ASA was best for COLONIC Crohn's, because the was the drug is released, most of it is active in the colon. Considering 40% of Crohn's is small bowel only, you can see why 5-ASA can't always be used.

Secondly, if we use the terms by strict definition, the 5-ASA drugs are usually only effective for INDUCING remission of mild to mild-moderate disease. Once these patients are no longer flaring, you don't need ANYTHING to keep them in remission. By remission, I mean the disease isn't active either pathologically and most importantly, symptomatically. I disagree somewhat with you that this hasn't been looked at because there have been a LOT of studying on this subject. In fact, one of the lead researchers in pharmacological therapy for Inflammatory Bowel disease in the WORLD comes from where I work.

I do agree that 5-ASA treatment alone would not do any good in maintenance of remission....why? Because 5-ASA has been shown to be a poor maintenance agent. The evidence lies in Methotrexate and Azathioprine (Imuran) as maintenance agents. When I say "evidence", I'm talking about evidence seen in large scale, multicenter clinical studies.

I also agree with you about doctors being in a rush to put patients in to remission; however, if things are done right by a gastroenterologist, this usually isn't a concern. Secondly, I don't think prednisone is overused at all. It is generally saved for people with high score on the "crohn's disease activity index" and especially those patients whose flares are so bad they require hospitalization. Plus, if the flare is really bad, a lot of gastros are turning towards early use of Infliximab (Remicade) anyway--especially in children.

Bottom line...I respect your views, and I totally can see where you're coming from; I guess I have just been exposed to different trends.

Question...why don't you undergo the ERCP to see if you have PSC? Don't you think it would be helpful? Have you ever had a p-ANCA drawn?